Community health nurse plays a central role in enhancing the delivery of health care at homes by linking patients to health care system. Additionally, community health nurse enhances the capacity of individuals, families, and communities by providing relevant care that improves quality of life and functioning during illness and end-of-life stages. According to Herbert, Moore, and Rooney (2011), community health nurse has a challenging responsibility because “end-of-life nursing encompasses many aspects of care: pain and symptom management, culturally sensitive practices, assisting patients and their families through the death and dying process, and ethical decision-making” (p. 325).
End-of-life nursing is critical as the case study provides a scenario where Mrs. Thomas, aged 56 years, is suffering from a terminal illness of breast cancer because she underwent mastectomy, chemotherapy, and radiation therapy, yet her condition continued to deteriorate with time.
Her husband whom she relies on support and care is also suffering from depression due to stress in his job and health condition of his wife. In the view of the case study, the family requires a community health nurse to help them overcome health challenges associated with their medical conditions. Therefore, this essay assesses the case study and develops an appropriate nursing plan that will help the family to overcome numerous challenges and improve their quality of life and functioning.
Nurses need to understand the essence of improving quality of life and promoting health among patients with terminal illnesses. Given that breast cancer is a terminal illness, nurses need to understand treatment and management interventions that improve quality of life and prolong the lives of the patients. As a nurse, I perceive that the nature of treatment and management interventions usually determines how patients cope with the negative impacts of breast cancer. Psychotherapy is one of the effective interventions that breast cancer patients require to improve quality of life and prolong their lives (Chopra & Kamal, 2012).
On this basis, I perceive that psychotherapy is an important intervention because breast cancer patients experience great distress as they struggle to overcome fears associated with their condition and impending death. As breast cancer patients undergo surgery, chemotherapy, and radiotherapy, they endure great pain. According to my perception, palliative care is necessary in the management of chronic pain associated with breast cancer and treatment interventions. Thus, I understand that psychotherapy and palliative care are critical interventions that improve quality of life and prolong lives of breast cancer patients.
The nature of social support that patients with chronic conditions receive determines their quality of life and health status. In this view, I perceive that social health is critical in improving and promoting quality of life among patients. From experience, I have learned that people with breast cancer are unable to perform their normal duties, and thus require support from family members, nurses, or community members. Moreover, I comprehend that during illness, breast cancer patients experience a sense of isolation and abandonment when they are unable to perform certain duties.
According to Chopra and Kamal (2012), the extent of perceived social support among patients with breast cancer determines social, physical, and psychological aspects of quality life. When friends and family members fail to provide essential social support, they plunge breast cancer patients into misery and isolation. In this view, I perceive that social support is integral in promoting quality of life among breast cancer patients. In addition to social support, I also comprehend that spiritual support is necessary in nursing care as it creates a sense of hope among breast cancer patients. Spiritual support complements social support, and thus aid in improving the quality of life and promoting health conditions of patients with breast cancer.
Three Strategies for Improving Quality of Life
One of the strategies of improving quality of life of Mr. and Mrs. Thomas is by providing comprehensive information about cancer through education. Comprehensive education about cancer in terms of causes, treatment, and management is imperative for the family to understand how to improve quality of life. In the case study, Mrs. Thomas has given up on the medication because she felt that she has taken too much of the palliative drugs and has become ‘addicted’ to them. Since she is experiencing great pain and under palliative care, it is necessary for her and the husband to understand the essence of palliative care.
Coward (2006) asserts that, “learning about treatment options for specific cancers reduces stress and empowers survivors to advocate for themselves” (p. 53). Thus, by understanding that palliative care is central to the management of breast cancer, Mrs. Thomas will adhere to palliative care. Given that she experiences great pain and may be unable to use her medication, she can receive help from her husband. Thus, educating Mrs. Thomas about the essence of palliative care is imperative in improving quality of life.
Since Mr. and Mrs. Thomas experience great distress that plunges them into depression, they need psychotherapy. Psychotherapy is an appropriate strategy of improving quality of life because it will enable them to cope with psychological problems. Mr. Thomas is very depressed due to his job and medical condition of her wife to an extent of experiencing suicidal feelings. Likewise, Mrs. Thomas is grappling with the reality that breast cancer has overwhelmed and threatened her life because she has lost her breasts, developed lymphedema, and lung cancer due to metastasis of breast cancer.
To alleviate their psychological problems, psychotherapy is essential as it enhances emotional adjustment, increases satisfaction with care, and strengthens coping capacity (Newell, Sanson-Fischer, & Savolainen, 2002). In this view, Mr. and Mrs. Thomas need psychotherapy so that they can control their stresses and support each other in the management of breast cancer. According to Klauner-Demore (2006), “among married women with cancer, partner support is viewed as the most crucial source of support and predicts lower levels of depression and anxiety and better quality of life” (p. 107). Thus, for Mrs. Thomas to receive necessary support from his husband, psychotherapy is essential.
The third strategy of improving quality of life is the one of changing lifestyle by eating appropriate nutrition and exercising well. The health condition of Mrs. Thomas is deteriorating with time because breast cancer is gradually metastasizing in the body. Moreover, use of palliative drugs has adverse effects, which require appropriate nutrition to alleviate the effects. Coward (2006) states that, “in women with breast cancer, dietary counseling, and reduced daily fat intake was associated with a reduced rate of recurrence and level of activity equivalent to walking 3 to 5 hours a week was associated with decreased mortality” (p. 53). On this basis, Mrs. Thomas needs to reduce dietary fat and increase physical activity for her to improve her physical ability and perform activities of daily living.
A Holistic Nursing Action Plan
Mrs. Thomas is experiencing chronic pain because her breast cancer gradually metastasizes in the body. Breast cancer is threatening to disable her completely because she cannot perform her clerical duties. In this view, a holistic action plan that will optimize her functional ability is the use of palliative drugs, appropriate nutrition, psychotherapy, and physical exercise. Palliative drugs are essential because they reduce chronic pain; hence, improve her physical ability. Since palliative care has adverse effects that often weaken the body, appropriate nutrition is necessary to alleviate the impact of the adverse effects.
Mrs. Thomas is also suffering from depression because she has fears about the loss of job, death, suicidal husband, and painful experience of breast cancer. To ease depression, psychotherapy provides an effective way of reducing stress and enhancing positive perception of life amidst numerous challenges. In the optimization of her functionality, daily performance of exercises is critical. According to Irvin, Muss, and Mayer (2011), regular endurance exercise reduces fatigue and enhances physical ability of patients with cancer. Thus, Mrs. Thomas should perform endurance exercise regularly to enable her regain her physical ability and carry out routine duties.
Once self-care is no longer possible for Mrs. Thomas, she will require additional care. For Mrs. Thomas to perform activities of daily living, she requires assistance from somebody who understands her condition. The assistance is critical because it makes Mrs. Thomas comfortable despite the fact that she is unable to take care of herself. Additionally, since Mrs. Thomas may fail to comply with palliative care, she requires someone who will ensure that she adheres to the palliative care.
To improve her health condition, Mrs. Thomas also needs to eat proper nutrition so that she can remain healthy and battle with cancer well. Irvin, Muss, and Mayer (2011) attribute poor nutrition and lack of enough physical activity to increasing cases of breast cancer morbidity and mortality. Thus, Mrs. Thomas should adhere to palliative care, proper nutrition, and possible activities to enable her overcome the disabling effects of the breast cancer.
Management of Chronic Depression
Given that Mr. Thomas is suffering from chronic depression, as a community health nurse, the appropriate intervention that will enable him to overcome the depression is to undergo psychotherapy. Psychotherapy will enable Mr. Thomas to cope with distressing conditions of the job and sickness of his wife. According to Newell, Sanson-Fischer, and Savolainen (2002), psychotherapy improves emotional adjustment, develops positive attitude, and promotes psychological coping skills. In this case, psychotherapy will change the way Mr. Thomas perceives his distressing conditions at the workplace and at home, and thus alleviate the depression.
Furthermore, constant encouragement of Mr. Thomas by the community nurse about the condition of her wife is essential because it will raise his hope and decrease depression. By helping Mrs. Thomas to perform activities of daily living as an act of social support is relevant since it has a significant impact in reducing depression. Hence, social support from the nurse, family, or community is vital in the alleviation of depression.
Community health nurses are important in the delivery of health care services because they bridge the gap between the home care and hospital care. The case study of Mr. and Mrs. Thomas shows that some health care services are appropriate when delivered at home by community health nurses because they effectively interact with members of the society. Analysis of the case study indicates that Mr. and Mrs. Thomas require comprehensive education so that they can understand the treatment and management of breast cancer. Moreover, they need to undergo psychotherapy so that they can alleviate depression, which complicates their lives. Ultimately, Mrs. Thomas needs to eat appropriate diet and perform physical exercises so that she can regain her physical ability.
Chopra, I., & Kamal, K. (2012). A systematic review of quality of life instruments in long-term breast cancer survivors. Health and Quality of Life Outcomes, 10(14), 1-15.
Coward, D. (2006). Supporting health promotion in adults with cancer. Family and Community Health, 29(1), 52-60.
Herbert, K., Moore, H., & Rooney, J. (2011). The Nurse Advocate in End –of-Life Care. The Ochsner Journal, 11(4), 325-329.
Irvin, W., Muss, H., & Mayer, D. (2011). Symptom Management in the Metastatic Breast Cancer. The Oncologist, 16(9), 1203-1214.
Klauner-Demore, N. (2006). Breast Cancer in Young Women. New York: IOS Press.
Newell, S., Sanson-Fischer, R., & Savolainen, N. (2002). Systemic Review of Psychological Therapies for Cancer Patients: Overview and recommendations for future research. Journal of the National Cancer Institute, 94(8), 558-584.